accessing a port for just one blood draw

~PedsRN~, BSN, RN · Jul 15, 2014

What's the lab? I feel like I would just go for a peripheral stick as well, depending on what the lab was. We have lots of labs that by policy aren't to be drawn from a port or a central line, even when they are already accessed - which sucks, but they are necessary evils.

gvrn13 · Jul 15, 2014

When I worked in oncology I would always ask the pt their preference. Some of them don't want to be stuck in the peripheral, and some have really bad IV access, so why wouldn't you use the port? A port needs to be accessed and flushed every 8 weeks or so, so if it would coincide with the lab draw, you would just get 2 things done at once. And on the flip side, some didn't want their port used because it took too long or what have you, and that was fine as long as it wasn't "scheduled" to be flushed. And I'm thinking that as long as it is done as a sterile procedure, you should be ok infection wise. (My opinion as somewhat of a still newbie nurse)

KelRN215, BSN, RN · Jul 15, 2014

I do this pretty much every day. Most of my patients (children) have ports because they're oncology patients. When we draw their labs at home, we access their ports to do so. I'm not doing a peripheral stick on a baby who sits still and claps through getting her port accessed. The only lab that I regularly draw that I KNOW can't be drawn via PAC is a lovenox level.

~PedsRN~, BSN, RN · Jul 15, 2014

I do this pretty much every day. Most of my patients (children) have ports because they're oncology patients. When we draw their labs at home, we access their ports to do so. I'm not doing a peripheral stick on a baby who sits still and claps through getting her port accessed. The only lab that I regularly draw that I KNOW can't be drawn via PAC is a lovenox level.

We have lots of ABX peaks and troughs that can't be drawn via a port... which really sucks when the kid is all accessed and hooked up anyway. :grumpy:

Obviously if they are a super hard stick or there is another reason you can't stick peripherally the port is of course the easier option (well, most of them - we had one girl who had a port under about forty pounds of breast tissue, it was like playing a bad game of darts to access that thing) - but for most of my kids a port access is more panic inducing than a lab draw! And they are all old hats with them!

classicdame, MSN, EdD · Jul 15, 2014

You are right. The purpose of the port is to access easily. Also, please note that the Infusion Nurses Society guidelines recommend NOT using heparin, due to risk of HIT. Normal saline is preferred.

~PedsRN~, BSN, RN · Jul 15, 2014

You are right. The purpose of the port is to access easily. Also, please note that the Infusion Nurses Society guidelines recommend NOT using heparin, due to risk of HIT. Normal saline is preferred.

Never?

I'd love to see a copy of these recommendations and the evidence behind them. I always feel like we use too much heparin. (We lock every central line with heparin PRN - on top of our flushing protocols when not infusing fluids.)

classicdame, MSN, EdD · Jul 15, 2014

Not sure if you can access the information from their website but you can try. I bought the Standards for my hospital's use. Cost is about $50, I think. Helps me create policies, etc. There are times when heparin is ok, of course, but not routinely and not for every patient. The reference list for flushing standards is four page columns, so I cannot address here.

www.ins1.org

OCNRN63, RN · Jul 15, 2014

Chemo has left my veins difficult to access, so I would much rather have a draw from my port than have someone digging around in my arm.

KelRN215, BSN, RN · Jul 15, 2014

Not sure if you can access the information from their website but you can try. I bought the Standards for my hospital's use. Cost is about $50, I think. Helps me create policies, etc. There are times when heparin is ok, of course, but not routinely and not for every patient. The reference list for flushing standards is four page columns, so I cannot address here.
www.ins1.org

2 IV RNs stated this was untrue in another thread: https://allnurses.com/nursing-patient-medications/how-does-heparinizing-933831-page2.html

I have never worked anywhere where we didn't flush ports with heparin at all times. 500 units with deaccessing and 50 units if left accessed.

It won't let me link directly to it but if you click the first link here, it says heparin is recommended: https://www.google.com/#q=infusion%20nurses%20society%20flushing%20protocols

imintrouble, BSN, RN · Jul 15, 2014

I know ports are better for the patient. I know it's easier on the patient, even it's just one lab.

But darn, it takes longer, it's more trouble for the nurse, and on a really busy shift why can't I just be a little callous and do it the easy way?

I had a patient with a port admitted for OBS. Peripheral site in ER, (they didn't want to access the port either) and one lab before discharge.

Lab didn't want to draw the patient, wanted me to access the port and get the blood. Pressured me. Talked to the patient til the patient asked for a port draw.

A serious waste of my time. Ok, if that makes me self centered and selfish, I'll own it.

Double-Helix, BSN, RN · Jul 16, 2014

Accessing a port vs doing a venipuncture isn't only a matter of time and convenience, it's also a much greater infection risk to the patient- many of whom are already immunocompromised. Our peds onco clinic will often do a fingerstick for basic labs vs either a venipuncture of accessing the port. If the child is due to come back the next day for chemo or a procedure, they will sometimes access the port and send the child home with the port accessed, if the family and child are agreeable to it.

Our hospital recently changed their heparin guidelines to reflect the new recommendations. Our new policy is:

Accessed port: If the port is to be used within 24 hours, lock with saline only. If it is not being used regularly, flush with 5mL of heparin 10 units/mL every 24 hours. Use 5mL heparin 100 units/mL when deaccessing or for monthly flushing IF the patient is over 10kg. If under 10kg, use the 100 units/mL concentration, but consider a smaller volume.